Learn Facility Medicaid Basics

We've created this step-by-step questionnaire to help you understand some of the basic rules of Medicaid. Set up your free consultation to discuss how these rules affect your Facility Medicaid eligibility.

Select answers to the questions below (in green) by clicking on your response. The answers will help you determine if an applicant is qualified for Medicaid based on your selections.

Is the applicant over the age of 65 or disabled?

In order to apply for Medicaid, an applicant must be over the age of 65 or deemed disabled by the state or federal government.

YES

NO

YES

The applicant meets the first requirement for Medicaid.

Move on to Question 2.

NO

If the applicant cannot qualify for SSI or SSDI, then apply for disability determination through the state.

The applicant does not meet the first requirement for Medicaid.

The next step is to apply for Social Security disability (SSI or SSDI).

If the applicant cannot qualify for SSI or SSDI, then apply for disability determination through the state.

Is the applicant's gross income under $2,205.00?

What's gross income? Gross income is the total of all of the applicant's monthly income, before any taxes or deductions are withheld. Examples of sources of income include: Social Security, pensions through prior employers (OPM or IPERS), wages from current employment, etc.

YES

NO

YES

The applicant meets the second requirement for Medicaid.

Move on to Question 3.

NO

The applicant does not meet the second requirement for Medicaid.

The next step is to consult with a lawyer and set up a Miller Trust in order to achieve eligibility. If the applicant or their family does not have the funds to hire an attorney, they can reach out to Iowa Legal Aid at no cost.

Is the applicant single or married?

The final requirement for Medicaid is determined by the applicant's total value of assets. The asset limit for a single person is different than that of a married person.

SINGLE

MARRIED

SINGLE

Move on to Question 4.

MARRIED

Skip Question 4. Move on to Question 5.

Is the total value of the single applicant's assets below $2,000.00?

What are assets? Assets include bank accounts, CDs, IRAs, 401Ks, life insurance with a cash value, vehicles, property, etc.

Which assets are exempt? The applicant's primary residence and most expensive vehicle are exempt. Any additional vehicles are considered assets. Any property that is not the applicant's primary residence is also an asset. Loans against non-exempt property or vehicles are taken into consideration and will influence the asset's valuation.

YES

NO

YES

The applicant meets the final requirement for Medicaid.

Submit a completed application to the Department of Human Services.

NO

The applicant does not meet the final requirement for Medicaid.

The next step is to spend down the applicant's assets in a Medicaid compliant manner. Speak with a Certified Medicaid Planner at Iowa Senior Planning to learn more about spending down assets without incurring future Medicaid penalties.

What is the total value of the applicant and spouse's assets?

What are assets? Assets include bank accounts, CDs, IRAs, 401Ks, life insurance with a cash value, vehicles, property, etc.

Which assets are exempt? The applicant's primary residence and most expensive vehicle are exempt. Any additional vehicles are considered assets. Any property that is not the applicant's primary residence is also an asset. Loans against non-exempt property or vehicles are taken into consideration and will influence the asset's valuation.

UNDER $26,000

$26,000 - $48,000

$48,000 - $241,800

ABOVE $241,800

UNDER $26,000

The applicant meets the final requirement for Medicaid.

Submit a completed application and a completed Resources Upon Entering a Medical Facility form to the Department of Human Services

How does Medicaid allot assets between the applicant and spouse?

The spouse at home will be attributed the spouses' combined assets.

Bob and Sue have $20,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted the total $20,000 of assets to keep.

EXAMPLE

Bob and Sue have $20,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted the total $20,000 of assets to keep.

$26,000 - $48,000

The applicant does not meet the final requirement for Medicaid.

The next step is to spend down the applicant's assets in a Medicaid compliant manner. Speak with a Certified Medicaid Planner at Iowa Senior Planning to learn more about spending down assets without incurring future Medicaid penalties.

The spouse at home will be given a maximum of $24,000, and the institutionalized spouse will be given the remainder. This remainder must be spent before the applicant is considered eligible.

How does Medicaid allot assets between the applicant and spouse?

The spouse at home will be given a maximum of $24,000, and the institutionalized spouse will be given the remainder. This remainder must be spent before the applicant is considered eligible.

Bob and Sue have $40,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $24,000 to keep, and Bob is allotted the remaining $16,000. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $14,000 ($16,000 - $2,000 = $14,000).

EXAMPLE

Bob and Sue have $40,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $24,000 to keep, and Bob is allotted the remaining $16,000. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $14,000 ($16,000 - $2,000 = $14,000).

$48,000 - $241,800

The applicant does not meet the final requirement for Medicaid.

The next step is to spend down the applicant's assets in a Medicaid compliant manner. Speak with a Certified Medicaid Planner at Iowa Senior Planning to learn more about spending down assets without incurring future Medicaid penalties.

How does Medicaid allot assets between the applicant and spouse?

Assets are divided 50/50 between spouses.

Bob and Sue have $100,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $50,000 ($100,000
/
2 = $50,000) to keep, and Bob is allotted the remaining $50,000. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $48,000 ($50,000 - $2,000 = $48,000).

EXAMPLE

Bob and Sue have $100,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $50,000 ($100,000
/
2 = $50,000) to keep, and Bob is allotted the remaining $50,000. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $48,000 ($50,000 - $2,000 = $48,000).

ABOVE $241,800

The applicant does not meet the final requirement for Medicaid.

The next step is to spend down the applicant's assets in a Medicaid compliant manner. Speak with a Certified Medicaid Planner at Iowa Senior Planning to learn more about spending down assets without incurring future Medicaid penalties.

The spouse at home will be given a maximum of $120,900, and the institutionalized spouse will be given the remainder. This remainder must be spent before the applicant is considered eligible.

How does Medicaid allot assets between the applicant and spouse?

The spouse at home will be given a maximum of $120,900, and the institutionalized spouse will be given the remainder. This remainder must be spent before the applicant is considered eligible.

Bob and Sue have $500,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $120,900 to keep, and Bob is allotted the remaining $379,100. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $377,100 ($379,100 - $2,000 = $377,100).

EXAMPLE

Bob and Sue have $500,000 in total assets. Bob is applying for Medicaid to pay for his nursing home care. Sue is allotted $120,900 to keep, and Bob is allotted the remaining $379,100. As a Medicaid applicant, Bob is allowed an asset limit of $2,000. So in order to be eligible, Bob must spend at least $377,100 ($379,100 - $2,000 = $377,100).

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